Endoscopic Treatment for Bleeding Peptic Ulcerations by Argon Plasma Coagulation
| Autor: | Ayako, Koitabashi, Yasunaga, Suzuki, Takahiro, Mitsuhashi, Takeshi, Oinuma, Yoshihito, Watanabe, Hideyuki, Hiraishi, Akira, Terano, Tetsuya, Nakamura |
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| Jazyk: | japonština |
| Rok vydání: | 2003 |
| Předmět: | |
| Zdroj: | Dokkyo journal of medical sciences. 30(1):79-84 |
| ISSN: | 0385-5023 |
| Popis: | 出血性消化性潰瘍に対する止血法として非接触法であるアルゴンプラズマ凝固法を施行しその有用性と安全性を検討した。出血性潰瘍と診断されアルゴンプラズマ凝固法による止血術がなされた胃潰瘍17例,十二指腸潰瘍6例計23症例を対象とした。静脈性出血である湧出性出血,動脈性出血である拍動性・噴出性出血および活動性出血のない露出性血管症例に対し第一選択として,またはクリッピング術にて止血の得られなかった症例に対しアルゴンプラズマ凝固法を施行した。全体での一次止血率は83%と高率であり,再出血率は21%であった。クリッピング術にて止血困難な症例に対しても75%と有効であった。部位別では内視鏡的に正面視し難い後壁病変でも86%と高い止血率であった。潰瘍出血に対するアルゴンプラズマ凝固法は,手技的に容易で偶発症も認めず安全で有用な止血法と思われた。 Background : Endoscopic treatment such as injection therapy and hemoclipping is known to be effective as hemostatic treatment for upper gastrointestinal bleeding. Argon plasma coagulation (APC) is a new modality of electrosurgery to apply high frequency electric current into tissue to cause defined thermal and coagulating effects and may be beneficial for hemostasis of gastrointestinal bleeding. The aim of the present study was to assess prospectively the usefulness of endoscopic APC for peptic ulcer bleeding. Methods Patients with upper GI bleeding manifested by hematemesis or melena were included in this study. APC was carried out with the use of argon source APC 300 and high frequency generator ICC 200 (ERBE, Germany) when active bleeding from an ulcer or a visible vessel in an ulcer bed was found. Results A total of 23 patients with bleeding from peptic ulcer underwent APC. Arterial spurting was found in 5 patients, oozing in 10 and a visible vessel in 8. Initial hemostasis was achieved in 19 of 23 patients (83%). With respect to the type of bleeding, hemostasis success was 4/5 (80%) in patients with spurting, 8/10 (80%) with oozing, and 7/8 (88%) with a visible vessel. In the particular patients in whom endoscopic clipping failed to get hemostasis, hemostasis was achieved in 6/8 (75%). In terms of location, the rate of hemostasis by APC was 8/9 (89%) for lesions located in the body, 4/4 (100%) in the angle, 3/4 (75%) in the antrum, and 4/6 (67%) in the duodenum, with no significant difference. For the posterior lesions where frontal access was hard to obtain, APC resulted in a higher rate of hemostasis (86%). Rebleeding within 10 days was observed in 4/19 (21%) after initial hemostasis. No serious complication was encountered. Conclusions Endoscopic APC for bleeding peptic ulcerations resulted in a higher rate of initial hemostasis with a considerably lower rate of rebleeding. In patients with unsuccessful hemostasis by endoscopic clipping, a high rate of hemostasis was achieved by APC. Thus, APC may provide an effective and safe modality for treatment of bleeding ulcerations. |
| Databáze: | OpenAIRE |
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